April 25, 2003
Clinical features and treatment of late enophthalmos after orbital decompression
A condition suggesting cause for idiopathic "imploding antrum" (silent sinus) syndrome
Ophthalmology,April,2003
Six patients experienced relative enophthalmos, hypoglobus, and upper eyelid sulcus deformity at between 3 and 6 months after bone-removing orbital decompression for thyroid orbitopathy. All patients underwent middle meatal antrostomy, together with mobilization and elevation of the collapsed orbital contents by firm packing of the affected maxillary antrum through a buccal antrostomy, the pack being removed about 3 weeks after placement.
After antral drainage and packing, there was an improvement in enophthalmos (mean, 2.7 mm; range, 0–4 mm) and all but one globe returned to within 2 mm of exophthalmometry of the contralateral eye. For recurrent enophthalmos in two patients (minor in one patient and marked in the other), later repair of the orbital floor was undertaken through a lower eyelid swinging flap, using porous polythene sheet, with good cosmetic outcome.
CONCLUSIONS: Late-onset enophthalmos after bone-removing orbital decompression seems to be the result of obstruction of maxillary antral aeration, with secondary fluid retention and a subatmospheric pressure in the sinus. This iatrogenic condition, associated in most cases with inward collapse of the maxillary walls, provides a guide to a hypothetical mechanism for the idiopathic imploding antrum (silent sinus) syndrome.
Posted by afarahi at April 25, 2003 10:46 PM